CASCADING DISSEMINATION OF A FOSTER PARENT INTERVENTION

寄养系统中的儿童数量越来越多，心理问题的风险很高，对养父母的挑战也越来越大。试图向这些儿童提供护理和养育的养父母往往在没有就发展和心理健康问题进行有意义或相关的咨询的情况下这样做。这项拟议的研究将测试旨在增加对养父母的支持和咨询的干预措施的有效性。这项研究的一个主要目的是测试拟议的干预措施从俄勒冈州转移到圣地亚哥六个卫生与公众服务区的寄养系统的可行性。提出了一种级联传播模式，原开发人员将在圣地亚哥培训和监督工作人员实施干预，在实施的第二次迭代中，原开发人员的参与将减少。该干预措施旨在为寄养父母提供一般支持和具体的父母管理培训(PMT)，这是一种有据可查的有效干预方法。在许多临床试验中，从学龄前儿童到青少年，PMT已被证明产生了积极的结果。此外，在以前的疗效试验中，PMT在三个方面对养父母产生了积极影响：(1)减少了儿童症状，(2)寄养中断的比率较低(因消极原因改变安置)，以及(3)PMT条件下的养父母较少退出提供寄养。结果将在多个层面上进行评估，包括儿童症状、功能行为、环境、消费者视角和使用多方法/多代理策略的系统。将评估执行的忠诚度，以及背景因素，包括组织氛围和养父母的社会孤立/孤立。据假设，与对照组相比，干预组的养父母将提高育儿技能，感受到更多的支持，并承受更少的压力，这反过来将导致更积极的儿童结果，包括报告的儿童症状较少，儿童在三个领域(即，家庭、学校、与同伴)的儿童功能行为水平较高。寄养父母结果和孩子结果的改善都被假设为预测系统层面的结果，包括儿童使用心理健康服务、养父母保留和安置中断。背景因素预计将通过实施保真度直接影响寄养父母的结果，间接影响儿童和系统的结果。

Children in the foster care system are growing in number, are at high risk for psychological problems, and are increasingly challenging to their foster parents. Foster parents who are trying to provide care and nurturing to these children are often doing so without benefit of meaningful or relevant consultation on developmental and mental health issues. The proposed study would test the effectiveness of an intervention intended to increase supports and consultation to foster parents. A major aim of this study is to test the transferability of the proposed intervention from Oregon to the foster care system in San Diego in six regions of Health and Human Services. A cascading dissemination model is proposed where, the original developers will train and supervise staff in San Diego to implement the intervention, and in the second iteration of the implementation, the involvement of the original developers will lessen. The intervention is designed to provide foster parents with general support and specific parent management training (PMT), a well- documented and effective intervention approach. PMT has been shown to produce positive outcomes in numerous clinical trials with diverse populations of youngsters from preschoolers to adolescents. In addition, in a previous efficacy trial, PMT had positive effects with foster parents in three areas: (1) reduction of child symptoms, (2) lower rates of disruptions in foster care (changes in placements for negative reasons), and (3) fewer foster parents in the PMT condition dropped out of providing foster care. Outcomes will be evaluated at multiple levels, including child symptoms, functional behavior, environments, consumer perspectives, and system using a multi- method/multi-agent strategy. Implementation fidelity will be assessed, as will contextual factors, including the organizational climate and social isolation/insularity of the foster parents. It is hypothesized that, compared to controls, foster parents in the intervention group will improve on parenting skills, feel more supported, and have less stress which will in turn result in more positive child outcomes, including fewer reported child symptoms and higher levels of child functional behavior in three domains (i.e, home, school, with peers). Improvements in foster parent outcomes and child outcomes are both hypothesized to predict system-level outcomes, including child use of mental health services, foster parent retention, and placement disruptions. Contextual factors are expected to impact foster parent outcomes directly and child and system outcomes indirectly, through implementation fidelity.